CEMACH

Chapter 1: Which mothers died, and why

Vulnerability

Ethnicity

The ethnic groups of all women who died were reported to the Enquiry, but the ethnic group of mothers in general is recorded only in England and not in the other countries of the United Kingdom. Since 1995, ethnic group information has been recorded in the Hospital Maternity Episode Statistics (HES) System for England, but coverage is still not complete. By the financial year 2004-05, ethnic group was recorded for 75% of deliveries in England for the years covered by this Report. A comparison of maternity HES data for 2000-01 with data about children under the age of one recorded in the 2001 census showed that the ethnic group distribution in HES delivery data was broadly comparable as long as maternities to women whose ethnic group was not stated are grouped with those to women whose ethnic group was recorded as White30. Maternity HES data for the financial years 2003-04 and 2004-05 have been grossed up to the total numbers of registered maternities in England in the 2003-05 triennium to produce the estimated maternities in Table 1.18. These have been used to produce estimated mortality rates and relative risks by ethnic group for England.

Table 1.18

Numbers and estimated rates of maternal death by type and ethnic group per 100,000 maternities;
England only: 2003-05.  

Ethnic group Direct deaths Indirect deaths Total Direct and Indirect deaths
Estimated
number of
maternities
  Numbers Numbers Numbers Rate 95 per cent CI for rate Relative risk
compared with
white
95 per cent CI
for relative risk
 
White 71 91 162 11.1 9.5 12.9 1.0  -  - 1,462,537
Mixed 0 1 1 5.2 0.9 29.5 0.5 0.1 3.4 19,232
Black African 15 15 30 62.4 43.7 89.0 5.6 3.8 8.3 48,103
Black Caribbean 7 2 9 41.1 21.6 78.1 3.7 1.9 7.3 21,910
Indian 2 7 9 20.3 10.7 38.6 1.9 0.9 3.6 44,288
Pakistani 3 3 6 9.2 4.1 20.1 0.8 0.4 1.9 64,993
Bangladeshi 3 3 6 23.6 10.8 51.4 2.1 0.9 4.8 25,455
Chinese and other Asian 1 0 1 14.0 2.5 79.2 1.3 0.2 9.0 7,146
Middle east 4 3 7 32.0 15.5 66.1 2.9 1.4 6.2 21,845
Other 1 1 2 28.0 7.7 10.2 2.5 0.6 10.2 7,146
Total 107 126 233 13.5 11.9 15.4       1,722,655

These rates and relative risks are based on small numbers and the coding of ethnicity may be problematic so they should be interpreted with caution. Nevertheless, analysis of the English data suggests that for Black African women and, to a lesser extent Black Caribbean and Middle Eastern women, the mortality rate is significantly higher than that for White women. This may not only reflect the cultural factors implied in ethnicity but their social circumstances and the fact that some of them may have recently migrated to the United Kingdom under less than optimal circumstances. Table 1.19 shows the main causes of death by ethnic group, and Table 1.20 their access to care.

Table 1.19 

Direct and Indirect maternal deaths by major ethnic group; England: 2003-05.

  White Black
African
Black
Caribbean
Indian Pakistani Bangla-
deshi
Chinese
and Asian
Middle
Eastern
Other Not
stated
Total
Direct                      
Thromboembolism 30 3 3 0 2 0 1 1 1 0 41
Pre-eclampsia / eclampsia 12 2 2 0 0 1 1 1 0 0 19
Haemorrhage 7 2 1 1 2 1 1 1 1 0 17
AFE 11 4 0 1 0 1 0 0 0 0 17
Early pregnancy 12 2 0 0 0 0 0 0 0 0 14
Sepsis 14 3 1 0 0 0 0 0 0 0 18
Anaesthetic 5 0 0 0 0 0 1 0 0 0 6
All Direct 91 16 7 2 4 3 4 3 2 0 132
Indirect                      
Cardiac 33 6 1 4 0 1 2 0 1 0 48